Effects of a health coaching program based on Cox's interaction model in older adults with diabetes mellitus in Korea: a quasi-experimental study.

Duggan, Hardy, and Waller present a systematic review and meta-analysis of cognitive-behavioural therapy (CBT) for outpatients with anorexia nervosa (AN) []. The review identified 26 studies and reported pre-to-post effects for weight, eating disorder (ED) symptoms, depression, anxiety, and quality of life, although the number of studies contributing data varied substantially by outcome []. Furthermore, across studies with calculable allocation and completer data, dropout was approximately 29.6% in aggregate and 31.5% as an unweighted study-level mean, with a median of 33.3% []. However, participants’ reasons for dropping out were not extracted or discussed, limiting interpretation of whether dropout reflected accessibility constraints, iatrogenic harm, or other acceptability-related concerns []. Duggan et al. concluded that the findings present an optimistic picture and that clinicians can expect good outcomes regardless of starting weight, age, or illness duration []. These conclusions require caution. CBT evidence claims are valid only within the populations, outcomes, and service contexts represented in the clinical trials, and should not be extended uncritically to under-represented groups, including trans and gender diverse individuals, neurodivergent people, and Indigenous, First Nations, and Māori communities []. Additionally, ED treatment benefit is not evidence of safety when iatrogenic harm remains underdefined, undermeasured, and underreported, and when patient reports of iatrogenesis are dismissed as resistance, non-compliance, lack of insight, or treatment-interfering behaviour []. Systematic reviews and meta-analyses matter because they can influence how treatments are perceived, recommended, funded, prescribed, delivered, and discussed across clinical, policy, and research settings [, –]. Findings of benefit therefore require careful interpretation: improvement in ED symptoms or weight does not, on its own, establish that a treatment is safe, adequately personalised, culturally valid, or appropriate for all groups to whom the findings may later be applied [–].